Jesly Pemicu 2 Respi

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Pemicu 2Mulutku tidak bisa dibukaJESLY CHARLIES, 405100171Kelompok 14_Blok Sistem Respirasi

Learning ObjectivesMenjelaskan anatomi faring, laring dan kepala leher; struktur yang ada di dalamnya; dan hubungannya.Menjelaskan kelainan di nasofaring.Menjelaskan kelainan di orofaring.Menjelaskan kelainan di laringofaring.Menjelaskan kelainan di kepala leher.

LO 2-5Definisi, etiologi, faktor risko & predisposisi, patofisiologi, klasifikasi, gejala dan tanda klinis, diagnosis & pemeriksaan, diagnosa banding, tatalaksana, komplikasi, prognosis.

LO1.Menjelaskan anatomi faring, laring dan kepala leher; struktur yang ada di dalamnya; dan hubungannya.

PharynxAdalah saluran pernapasan (dan pencernaan) bagian atas, terletak di belakang hidung, rongga mulut, dan larynx.Batas Superior : basis craniiInferior : Anterior : pinggir inferior cartilago cricoideaPosterior : pinggir inferior vertebra C6Pharynx dibagi 3:NasopharynxOropharynxLaryngopharyx

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1. NasopharynxBatas-batas Anterior : choanaSuperoposterior : permukaan inferior corpus os sphenoidalis dan pars basilaris os occipitalisInferior : palatum molleAda 5 saluran : 2 tuba eustachius, 2 choana, pintu ke oropharynxTerdapat tonsilla pharyngealis

2. Oropharynx Batas-batasAnterior : faucium (isthmus oropharyngeal)Superior : palatum molleInferior : epiglottisTerdapat :Tonsilla palatina 2 buahTonsilla lingualis

3. LaryngopharynxBagian dr saluran pencernaan dan pernapasanBatas-batasSuperior : epiglottisInferior :Anterior : pinggir inferior cartilago cricoideaPosterior : pinggir vertebra C6Berhubungan dg larynx melalui aditus laryngeus

LarynxLarynx kompleks organ yg berfungsi memproduksi suara, terletak di leher depan setinggi vertebrae C3-C6, menghub laryngopharynx dg tracheaFungsi :Sbg katup yg menjaga agar tractus respiratorius tdk kemasukan makanan sewaktu menelanPengatur banyaknya udara yg masuk sesuai dg berbagai keaktifanVokalisasi

Rangka pembentuk larynxCartilago thyroidea terbesar, cartilago hyaline, > , tdr ats 2 lamina yg bsatu di anterior membentuk prominencia laryngea (adams apple), yg lbh menonjol pd priaCartilago cricoidea bbtk cincin stempel, bag anterior > rendah = arcus, bag posterior > tggi = laminaEpiglotis cartilago elastin bbtk spt daun, bersifat elastis, tltak di posterior radix lingua& os hyoideum, dianterior aditus laryngeus, bgrak membuka/menutup aditus laryngeus ketika menelan makananCartilago arytoneidea (2) bbtuk segitiga, tltak datas lamina cartilago cricoidea, berperan dlm pmbtkan suaraCartilago corniculata (2) menempel pd apex cartilago arytenoidea, muncul sbg nodul kcl di bag posterior plica arypiglittica, menyokong struktur epiglotisCartilago cuneiformis (2) tltak didepan cartilago corniculata, muncul sbg nodul kecil di bag posterior plica arypiglottica, tdk meempel/berhub dg cartilago lain, menyokong struktur epiglotis

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LO2.Menjelaskan kelainan di nasofaring.

Cincin Waldeyer terdiri atas susunan kelenjar limfe yg terdapat di nasofaring dan orofaring yaitu:tonsil faringeal (adenoid)tonsil palatinatonsil lingualtonsil tuba Eustachius (tonsil tubaria)

AdenoidAdenoid produce B cells give rise to IgG & IgA.Serve as immunological memory in younger children.The adenoid may be implicated in upper respiratory tract disease due to partial or complete obstruction of the nasal choanae or as a result of sepsis.

Clinical Grading of Adenoid Size (Clemens et al.)GradeDescriptionGrade IAdenoid tissue filling one-third of the vertical portion of the choanaeGrade IIAdenoid tissue filling one-third to two-thirds of the choanaeGrade IIIFrom two-thirds to nearly complete obstruction of the choanaeGrade IVComplete choanal obstruction

Adenoid Hypertrophy

Adenoid HypertrophyPertumbuhan berlebihdarijaringan limfoidsekitar umur 3 sampai 8 tahundapat menunjukkangejala seperti: Snoring (mendengkur)Mouth breathingApneaDysphagiaMungkin mempunyai riwayat:Snorting (mendengus)Gasping (terengah-engah)Hyponasal speechRestless sleepEnuresis (ngompol)Growth disturbanceFailure to thrive

Adenoid HypertrophyPF tonsilar hypertrophyEndoscopy or lateral soft tissues radiographs adenoid hypertrophyLymphoid hypertrophy and relaxation of the pharyngeal musculature during sleep increases the obstructionChildren craniofacial anomalies / neuromuscular disorders

Causing:FeverSore throatOdynophagia (painful swallowing)MalaiseOropharyngeal erythemaEdemaExudatesRash or lymphadenopathy

Tonsillectomy/AdenoidectomyIndication of Tonsillectomy +/- AdenoidectomyAbsolute indicationsUpper airway obstructionSevere dysphagiaCardiopulmonary complicationUnresponsive or recurrent peritonsillar abscessTonsillitis with febrile convulsionsBiopsy needed for tissue pathologyRelative indications3 or more tonsillar infections per year despite proper medical treatmentPersistent foul taste or halitosisChronic or recurrent tonsillitis in a streptococcal carrier unresponsive to medical managementUnilateral tonsillar hypertrophy presumed to be of neoplastic origin

Complications of AdenoidectomyBleedingDental traumaAirway obstruction (retained swab, nasopharyngeal blood clot)InfectionCervical spine injuryVelopharyngeal dysfunctionRegrowth of adenoid

LO3.Menjelaskan kelainan di orofaring.

Acute PharyngitisAcute pharyngitis: common inflammation of the pharynx and tonsils.Gejala utama acute onset sore throat

Etiology of Pharyngitis

PathophysiologyBacteria or viruses may directly invade the pharyngeal mucosa local inflammatory response.Rhinovirus irritation of pharyngeal mucosa secondary to nasal secretion.Streptococcal infections local invasion and release of extracellular toxins and proteases.

TonsillitisThe causative organism in acute suppurative tonsillitis is GABHS.Diagnosis, based on a history of:Pyrexial illnessSore throat with a painful swallowPharyngeal erythema with or without tonsillar exudates and painful cervical adenopathy

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Diagnosis of Causative AgentBacteriological culture of a throat swab (+) culture for GABHSRapid Antigen Testing (RAT)

Complication of acute tonsillitisSystemic sepsis septicaemia, septic arthritisGABHS acute exanthematous reaction with a macular rash scarlet feverNoninfective sequelae of GABHS rheumatic fever and glomerulonephritis (under Immunocomplex disorders)Peritonsillar abscess (Quinsy)Retropharyngeal abscessParapharyngeal abscessLemierres syndrome

Peritonsillar Abscess (quinsy)Peritonsillar Abscess a collection of pus forms in the potential space between the tonsil and its bedAnaerobic organism and GABHSPresentation:Severe pharyngitisServere trismusAirway compromise and dehydrationProgressiveUnilateralDysphagiaTrismusDrooling of salivaIpsilateral lymphadenopathyOdynophagiaIpsilateral otalgiaEnlarged jugulodigastric node

Peritonsillar Space InfectionsKomplikasi dr tonsillitisGambaran klinis:MerahTonsil bengkak bilateral, biasanya eksudatPembengkakan signifikan di lateral dan superior tonsil pada 1 sisiKasus berat uvula displaced krn efek dr adanya masaNyeri saat membuka mulut jika infeksi dan inflamasi meluas ke M.pterygoid internal di parapharyngeal spaceSerious peritonsillar space infections severe cellulitis and abscessNyeri saat membuka mulut ada absesTidak nyeri saat membuka mulut tdk ada abses

Strep viridans , Stap aureus, H influenzaeRisk of aspiration use of local anesthesia prior to incision exacerbates this riskTreatment high dose penicillin IV or cephalosporin, erythromicin, incision and drainage

Retropharyngeal abscessS.viridans , S.aureusTreatment high dose AB + urgent incision and drainagefever, irritability, lymphadenopathy, poor oral intake, sore throat, droolingpain, dysphagia, snoring, nasal obstruction,Dyspnea and respiratory distressLateral posterior oropharyngeal wall bulge

Retropharyngeal Space InfectionsGejala klinis:DemamDisfagiaIrritabilityMuffled (teredam) cry or speechTorticollisStertorDrooling and stridor kasus berat

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Parapharyngeal abscessKlebsiella pneumoniae, streptococcus viridansTreatment penicillin, broad spectrum AB IV, aspirationPatient usually severely systemically unwell, with severe trismus and possibly airways compromise

Recurrent streptococcal tonsillitis is diagnosed when an individual has 7 culture-proven episodes in 1 year, 5 infections in 2 consecutive years, or 3 infections each year for 3 years consecutively.Individuals with chronic tonsillitis may present with chronic sore throat,halitosis, tonsillitis, and persistent tender cervical nodes.Individuals with peritonsillar abscess (PTA) present with severe throat pain, fever, drooling, foul breath, trismus (difficulty opening the mouth), and altered voice quality (the "hot potato" voice).

EtiologyHSVEBVCytomegalovirusOther herpes virusesAdenovirusMeasles virusGABHSS pyogenesNeisseria gonorrheaS penumonia, Stap aureus, H influenzae (recurrent)Bacteroides fragilis (anaerob recurrent tonsillitis)

DiagnosisRapid antigen testing of a throat swab for GABHSBacterial cultureClinical assessment

TreatmentSupportive analgesics and adequate hydrationAntibiotic benzylpenicillin (if theres no sign of improvement within 48-72 hours or in whom there is clinical concern because of the severity of symptoms)

TONSILITIS AKUTGEJALAPEMERIKSAANTERAPITonsilitis viralMenyerupai common cold disertai rasa nyeri tenggorokanRongga mulut tampak luka kecil pada palatum dan tonsil yang sangat nyeri dirasakan pasienIstrahat, minum cukup, analgetika dan antivirus di beri jika gejala beratTonsilitis bakterialNyeri tenggorokan dan telan, demam, lesu, rasa nyeri sendi, tidak nafsu makanTonsil membangkak, hiperemis dan kelenjar submandibula membengkak dan nyeri telanAntibiotika spektrum lebar penisilin, eritomisin, antipiretik